Prevention of Cardiovascular Events with an Antihypertensive Regimen of Amlodipine Adding Perindopril as Required versus Atenolol Adding Bendroflumethiazide as Required, in the ASCOT-BPLA
2005 · paper · Clinical trials
A randomized trial in 19,257 hypertensive patients comparing an amlodipine-based regimen (adding perindopril) with an atenolol-based regimen (adding bendroflumethiazide). The primary endpoint was non-fatal myocardial infarction and fatal coronary heart disease.
2 findings
Substance Figure 4, primary endpoint, amlodipine column: "429 (5%)" with n=9639; 429/9639 is 4·45%, which rounds to 4%.
- p. 5 Figure 4, primary endpoint row, amlodipine column
429 (5%)
Judge's note: The Figure 4 crop shows 429 (5%) under the header n=9639. The other rows round correctly against the arm n: 390/9639 gives 4%, and 474/9618 is 4·93%, giving 5%. Only this cell is off.
Second check: another model agreed
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Reference or label Reference 14 prints the volume as 6: "J Hypertens 2001; 6: 1139–47." Going by the other J Hypertens entries in the same list, the volume would be 19, and 6 looks like the issue number.
- p. 12 Reference 14
J Hypertens 2001; 6: 1139–47.
Only the authors can say what is right here.
Judge's note: Rests on outside knowledge: J Hypertens 2001 is volume 19 (issue 6). The crop of p12 shows "J Hypertens 2001; 6: 1139–47." with the 6 in bold, where the volume normally goes. Inside the same list, J Hypertens 2002 is vol 20 (ref 19), 2003 is vol 21 (refs 4, 6) and 2004 is vol 22 (ref 26), so a 2001 volume of 6 is out of line. The exact correct volume can't be checked from these files.
Second check: another model agreed
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15 minor (typos and the like; most checked by the judge only)
Substance Results: "complete endpoint information ... for 18 965 people (99%; figure 1)"; 18 965/19 257 is 98·5%, which rounds to 98%.
- p. 6 Results, first paragraph
18 965 people (99%; figure 1)
- p. 2 Figure 1
9518 complete information
Judge's note: Figure 1 gives 9518 + 9447 = 18 965 patients with complete information. Out of 19 257 evaluable patients that is 98·48%. Out of 19 342 randomised it would be 98·05%. Neither denominator rounds to 99%. The discrepancy is small.
Second check: another model agreed
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Substance Figure 7, 'Age older than 60 years': "1001 (17%)" and "1186 (20%)"; against Table 2 (>60: 6081 and 6084) these are 16·5% and 19·5%, which round to 16% and 19%.
- p. 8 Figure 7, 'Age older than 60 years' row
1001 (17%)
- p. 8 Figure 7, 'Age older than 60 years' row, atenolol
1186 (20%)
- p. 3 Table 2, age >60
6081 (63%)
Only the authors can say what is right here.
Judge's note: Every other subgroup row checks against the Table 2 denominators: diabetes 430/2567=17%, 493/2578=19%; smokers 495/3168=16%, 612/3109=20%; female, male and LVH also match; age ≤60 gives 361/3558=10% and 416/3534=12%. Only the >60 row fails, and both values sit just below .5. Only the authors can say whether the subgroup denominators differ or the percentages are mis-rounded.
Second check: another model agreed
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Wording Abstract Findings: "Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint (... p=0·1052), fatal and non-fatal stroke (... p=0·0003), total cardiovascular events and procedures (... p<0·0001), and all-cause mortality (... p=0·025)": the 'not significant' qualifier reads as covering the whole list.
- p. 1 Summary, Findings
Though not significant, compared with the atenolol-based regimen, fewer individuals on the
Judge's note: I checked the Summary on page 1 in the crop. Only the primary endpoint is non-significant (p=0·1052). The other listed outcomes have p≤0·025. Read literally, the sentence puts every outcome under 'not significant'. The printed p values make the intended meaning clear, so this is a wording ambiguity only.
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Wording Results: "the baseline characteristics of the 19 257 patients randomised", whereas Figure 1 shows "19 342 randomised" and "19 257 evaluable" after 85 exclusions.
- p. 5 Results, first paragraph
characteristics of the 19 257 patients randomised
- p. 2 Figure 1
19 342 randomised
- p. 5 Results first paragraph
baseline characteristics of the 19 257 patients randomised
Judge's note: Figure 1 (page 2) gives 19 342 randomised, 85 excluded and 19 257 evaluable. The Results text on page 5 calls the 19 257 'randomised'. The same paragraph goes on to say that 85 patients were excluded, so readers are told about the gap. The label is loose rather than a wrong count.
Second check: another model agreed
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Wording Discussion: the regimen "is better ... in terms of reducing the incidence of all types of cardiovascular events and all-cause mortality", while Figure 4 shows non-significant results for several cardiovascular endpoints, some with HR >1.
- p. 7 Discussion, first paragraph
terms of reducing the incidence of all types of
- p. 5 Figure 4
1·27 (0·80–2·00)
- p. 7 Discussion, first paragraph
terms of reducing the incidence of all types of cardiovascular events and all-cause mortality
- p. 7 Discussion para 1
in terms of reducing the incidence of all types of
Only the authors can say what is right here.
Judge's note: In Figure 4, five cardiovascular endpoints are non-significant: the primary endpoint (0·90, p=0·1052), heart failure (0·84, p=0·1257), silent MI (1·27, p=0·3089), chronic stable angina (0·98, p=0·8323) and arrhythmias (1·07, p=0·8009). The next sentence of the Discussion itself says the regimen was not significantly more effective for non-fatal MI or fatal CHD. 'All types' is broader than the tabulated results support. The authors could clarify what the phrase is meant to cover.
Second check: another model agreed
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Wording The Table 4 inclusion rule is stated two ways: the text says "more than 5% in at least one treatment group and a difference of at least 1% between groups"; the caption says "more than 5% in one treatment group and a difference between treatment groups of more than 1%".
- p. 7 Results, last paragraph
a difference of at least 1%
- p. 9 Table 4 caption
a difference between treatment groups of more than 1%
- p. 7 Results, last paragraph
a difference of at least 1% between groups are given in table 4
Judge's note: I compared the Results text on page 7 with the Table 4 caption on page 9 and confirmed the ≥1% vs >1% wording. Every row that is visible differs by more than 1 point, so the table content does not show which rule was used. This is a wording inconsistency only.
Second check: another model agreed
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Typo Abstract Methods: "silent myocardial infaction" should read "infarction".
- p. 1 Summary, Methods
silent myocardial infaction
Judge's note: The page 1 crop shows 'infaction'. It is a misspelling in the published text, not an extraction artefact.
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Typo Discussion: "was not siginificantly more effective" should read "significantly"; also Acknowledgments "Drug were supplied" (number agreement).
- p. 7 Discussion, first paragraph
not siginificantly more effective
- p. 7 Discussion, first paragraph
regimen was not siginificantly more effective at reducing
- p. 7 Discussion, first paragraph
was not siginificantly more effective
- p. 1 Abstract
silent myocardial infaction
Judge's note: Both are visible in the crops from pages 7 and 12. The other misspellings bundled into this cluster (infaction, generalisibility, Cardiovasular, Amlopidine, inititated) are judged separately under C002, C014, C007, C004 and C003.
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Typo Methods, Participants: "investigator-inititated" should read "investigator-initiated".
- p. 2 Methods, Participants
inititated
Judge's note: The page 2 crop shows 'inititated'.
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Typo Figure text spells the drug "Amlopidine-based regimen" (Figures 2, 3, 5, 6 legends and number-at-risk rows) instead of "Amlodipine".
- p. 3 Figure 2 legend
Amlopidine-based regimen
- p. 4 Figure 3 number at risk
Amlopidine-based regimen
- p. 6 Figure 5 legend/number at risk
Amlopidine-based regimen
- p. 7 Figure 6 legend/number at risk
Amlopidine-based regimen
Judge's note: The embedded figure text layer reads 'Amlopidine-based regimen' at every figure-legend and number-at-risk occurrence (main.txt lines 472, 623, 626, 885–898, 957, 1174–1175). I looked at the crops for Figures 2, 3, 5 and 6 and the legend glyphs match that spelling. The Figure 4 axis label 'Amlodipine-based regimen better' is spelled correctly. Some reviewers said the number-at-risk labels are spelled correctly, but the text layer shows them misspelled too.
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Typo Figure 4 row label: "Cardiovasular death+myocardial infarction+stroke" should read "Cardiovascular".
- p. 5 Figure 4, post-hoc endpoints
Cardiovasular death+myocardial
Judge's note: The misspelling is visible in the Figure 4 crop on page 5.
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Typo Discussion: "generalisibility of the overall findings" should read "generalisability".
- p. 9 Discussion
generalisibility of the overall findings
Judge's note: The misspelling is visible in the page 9 crop.
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Typo ASCOT Investigators (Sweden): "G R_ter" contains an underscore in place of a letter.
- p. 11 ASCOT Investigators, Sweden
G R_ter
Only the authors can say what is right here.
Judge's note: The page 11 crop shows the underscore in the printed name, so it is not an extraction artefact. Only the authors can supply the correct letter.
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Typo Reference 5 misspells 'report': "The JNC7 teport."
- p. 12 Reference 5
The JNC7 teport.
Judge's note: The page-12 image clearly shows "The JNC7 teport." in reference 5, so this isn't an extraction artefact. It's a typo for 'report'.
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Typo Subject and verb disagree in the Acknowledgments: "Drug were supplied by Leo Laboratories". It should read "Drugs were supplied".
- p. 12 Acknowledgments
Drug were
- p. 12 Acknowledgments
Drug were supplied by Leo Laboratories
Judge's note: The page-12 Acknowledgments crop shows "Drug were" broken across a line and continuing as "supplied by Leo Laboratories". A singular noun with a plural verb is a grammar slip.
Second check: none (judge only)